MOA

• licensed for 5 years use (Jadelle)

• long acting reversible method of contraception

• primary MOA prevent ovulation

• change cervical mucus

• highly effective

• failure \<1/1000 over 3 years

insertion

• may start up to and including D5

  • no additional

• if after that excluding pregnancy

  • 7 day rule

issues

• bleeding

  • unscheduled bleeding in first 3mo = common

  • associated with unpredictable bleeding patterns

  • 17% have increased bleeding

  • 6% frequent bleeding

  • exclude gynaecological pathology

  • consider:

    • COC - if eligible

    • (doxycycline stop episode of uterine bleed)

• drug interactions:

  • concomitant use of enzyme-inducing drugs may reduce efficacy of progestogen-only implant

  • advised to switch to method unaffected by enzyme-inducing until 28d after stopping

• weight

  • no increase risk of pregnancy demonstrated in women up to 149kg

• non palpable implant

  • barrier until implant confimed

    • USS

    • (XR)

    • NOT exploratory surgery

  • if not seen on USS

    • consider MRI/other insertion sites